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Stakeholder Insight: Non-Hodgkin's Lymphomas Diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL)

Description:
The treatment outcomes for diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) patients have improved since the introduction of Rituxan/MabThera (rituximab; Biogen Idec/Genentech/Roche/Chugai/Zenyaku Kogyo). However, an unmet need remains for novel agents with improved efficacy and toxicity profiles, particularly in the treatment of relapsed and refractory patients.

Scope


- Analysis of the DLBCL and FL market based on a survey of 180 non-Hodgkin's lymphomas specialists, supported by interviews with key opinion leaders

- Forecast of the DLBCL and FL patient populations in the seven major pharmaceutical markets

- In-depth analysis of treatment patterns, regimens prescribed and treatment outcomes for DLBCL and FL patients

- Discussion of unmet needs and overview of late-stage pipeline drugs and marketed drugs investigated for expansion into the DLBCL and FL settings


Highlights of this title

Treatment of DLBCL patients with Rituxan has increased cure rates. However, relapsed/refractory patients who are ineligible for stem cell transplant and patients who relapse following transplantation continue to have a poor prognosis. The drugs currently in late Phase development for DLBCL are expected to have minimal impact on patient prognosis.

Current treatment options in advanced FL are rarely curative but Rituxan has been shown to improve prognosis. Patients with advanced disease inevitably relapse and require further treatment. A need remains for novel therapies in the treatment of relapsed/refractory FL to improve survival rates in this hard-to-treat patient population.

The combination of Treanda (bendamustine) with Rituxan has a favorable toxicity profile and has been shown to be effective in the treatment of low-grade NHL. Recent promising clinical trial results suggest that this drug combination has the potential to become a standard of care in the treatment of patients with FL.

Key reasons to purchase this title


- Understand prescribing trends in the DLBCL and FL markets

- Examine unmet need within the DLBCL and FL markets and identify opportunities for new product development

- Enhance commercial positioning by increasing understanding of current dynamics within the DLBCL and FL markets
 
Contents:
CHAPTER 1 EXECUTIVE SUMMARY
Scope of the analysis
Datamonitor insight into the NHL market
Contributing experts
Related reports
Upcoming related reports
CHAPTER 2 INTRODUCTION AND SCOPE
Disease definition and epidemiology
Current treatment practice for DLBCL and FL
Treatment trends for DLBCL and FL
Improving treatment outcomes
Assumptions and caveats
CHAPTER 3 EPIDEMIOLOGY AND PATIENT SEGMENTATION
Introduction
Disease classification
NHL is classified under the WHO classification system
NHL can follow an aggressive or indolent disease course
Diffuse large B-cell lymphoma (DLBCL) is an aggressive lymphoma
Follicular lymphoma (FL) is an indolent lymphoma
FL is graded according to the proportion of large cells in the lymphoma
Immunophenotype differs between NHL subtypes
Diagnosis, staging and prognosis in non-Hodgkin’s lymphomas (NHL)
Diagnosis of NHL
Ann Arbor staging system
The Ann Arbor classification is used for staging NHL but is of limited prognostic use
Determining prognosis for NHL
International Prognostic Index (IPI) for aggressive NHL
International Prognostic Index for FL (FLIPI)
Molecular profiling in NHL
Etiology
Immunodeficiency and immunosuppression as risk factors for non-Hodgkin's lymphomas (NHL)
Acquired immunodeficiency syndrome (AIDS)
Congenital immunodeficiency
Immunosuppressive drugs
Autoimmune disorders
Infections as risk factors for NHL
Human T-cell lymphotrophic virus (HTLV-1)
Epstein-Barr virus (EBV)
Helicobacter pylori
Hepatitis C
Occupational, environmental and lifestyle risk factors
Pesticides
Lifestyle factors
Epidemiology
NHL cases will total over 125,000 in the seven major markets in 2009
Increase in NHL incidence linked to an aging population
Forecast incidence of diffuse large B-cell lymphoma (DLBCL) in the seven major markets
DLBCL is the most common subtype of NHL
Forecast incidence of follicular lymphoma (FL) in the seven major markets.
FL is the second most common subtype of NHL
CHAPTER 4 TREATMENT TREES: DIFFUSE LARGE B-CELL LYMPHOMA
Introduction
Diffuse large B-cell lymphoma (DLBCL) treatment trees
US
Japan
France
Germany
Italy
Spain
UK
CHAPTER 5 TREATMENT TRENDS: DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL)
Overview
Treatment rates
Induction therapy
R-CHOP is a standard of care for induction therapy in DLBCL
Maintenance therapy
Second-line therapy
Candidates for stem cell transplantation (SCT)
Non-candidates for stem cell transplantation (SCT)
Stem cell transplantation (SCT) in diffuse large B-cell lymphoma (DLBCL)
Third-line therapy
Relapse following second-line chemotherapy and stem cell transplantation (SCT)
Relapse following second-line chemotherapy alone
CHAPTER 6 IMPROVING TREATMENT OUTCOMES: DIFFUSE LARGE B-CELL LYMPHOMA
Treatment outcomes
Unmet needs
Determining the best salvage therapy for patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL)
Inclusion of molecular profiling in current treatment strategies
Factors influencing prescribing decision in diffuse large B-cell lymphoma (DLBCL)
Efficacy is the most important prescribing influence for DLBCL
Incorporation of pipeline drugs into treatment
Pixantrone (Cell Therapeutics/Roche)
The uptake of pixantrone will depend on its toxicity profile
Afinitor (everolimus; Novartis)
Afinitor may struggle to secure approval as a maintenance therapy for DLBCL
Arzerra (ofatumumab; Genmab/GlaxoSmithKline)
Genmab shifts its attention to DLBCL
Avastin (bevacizumab; Genentech/Roche/Chugai)
Whether the addition of Avastin to R-CHOP improves outcomes in DLBCL is still unclear
Revlimid (lenalidomide; Celgene)
Revlimid shows good single-agent activity in relapsed/refractory DLBCL patients
Enzastaurin (Eli Lilly)
Enzastaurin shows marginal single-agent activity in relapsed/refractory DLBCL
CHAPTER 7 TREATMENT TREES: FOLLICULAR LYMPHOMA
Introduction
Follicular lymphoma (FL) treatment trees
US
Japan
France
Germany
Italy
Spain
UK
CHAPTER 8 TREATMENT TRENDS: FOLLICULAR LYMPHOMA (FL)
Overview
Treatment rates
Induction therapy
R-CHOP and R-CVP are the most popular induction regimens
The advantage of multiple courses of Rituxan remains unclear
Considerable uptake of Rituxan monotherapy in the induction setting
Maintenance following induction therapy
Rituxan maintenance after first-line and second-line therapy improves PFS and overall survival in FL
Second-line therapy
Stem cell transplantation (SCT) in follicular lymphoma (FL)
The use of reduced-intensity conditioning (RIT) may make allogeneic stem cell transplantation (alloSCT) feasible in more patients
Treanda in the treatment of follicular lymphoma
Radioimmunotherapies in the treatment of follicular lymphoma
Maintenance following second-line therapy
Third-line therapy
CHAPTER 9 IMPROVING TREATMENT OUTCOMES: FOLLICULAR LYMPHOMA (FL)
Treatment outcomes
Unmet needs
Novel therapies are required to improve treatment outcomes
Factors influencing prescribing decisions in follicular lymphoma (FL)
Efficacy is the most important prescribing decisions for FL
Incorporation of pipeline drugs into treatment
Velcade (Millennium/Johnson & Johnson)
The combination of Velcade with Rituxan is active in the first-line treatment of indolent non-Hodgkin's lymphomas (NHL)
It is unclear how Millennium will position Velcade in the treatment of FL
BiovaxID (Biovest/Accentia)
Phase III trial data show improvement in PFS, but are not clinically relevant
Galiximab (Biogen Idec)
Pixantrone (Cell Therapeutics/Roche)
Two Phase III trials in indolent non-Hodgkin's lymphomas (NHL) have been closed
BIBLIOGRAPHY
Journal papers
Websites
Datamonitor reports
APPENDIX A
Physician research methodology
Physician sample breakdown
US
Japan
France
Germany
Italy
Spain
UK
Contributing experts
APPENDIX B
The survey questionnaire
Introduction
Section 1 - Diffuse large B-cell lymphoma: Patient Segmentation
Section 2 - Diffuse large B-cell lymphoma: Treatment
Section 3 - Diffuse large B-cell lymphoma: Product Profiles and Pipeline Products
Section 4 - Follicular lymphoma: Patient Segmentation
Section 5 - Follicular lymphoma: Treatment
Section 6 - Follicular lymphoma: Product Profiles and Pipeline Products
About Datamonitor
About Datamonitor Healthcare
About the Oncology analysis team
Disclaimer


 
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